Jay Johnson

True, but the veteran has the power to pick and choose the information the VA sees when he/she uses a civilian psych, just as the VA can pick and choose their information when they use the VAMC. If there is NO information for the VA to draw from in a P&T case, then the most they can do is order a C&P (illegally without new and material evidence, but's that's another debate) and one C&P will not out weigh a treating psychiatrist's opinion by a long shot; especially if the treating psych has a long history with the veteran and gives a very favorable, and detailed, evaluation.

Honestly, if the VA just followed their own rules, we wouldn't have anything to fear. For instance, it wouldn't matter if they started digging into PTSD appointment logs at the VAMC if they just followed the regs which state that in order to reduce a 100% vet the VA must prove that the veteran has gotten better WITHOUT the need of doctors and/or meds and under real life conditions. But we all know this isn't the case and if the RO gets wind of a report saying something as simple as "little sally veteran seems to have had a good day today" they will throw little sally under a bus to prove she isn't "better". Thus the need to keep them as far away from PTSD vets as humanly possible..... But this won't change until we can hold raters accountable for failing to follow simple and clear regulations that they should be following anyway.....in my opinion, every time a rater ignores those regs they should be held in contempt of congress.

Hence why I think all PTSD vets at 100% should seek healthcare in the civilian community....even if it means costing you a lot of money. 1 or 2 thousand a year in medical expenses is better than losing 20K+ a year because the VARO got ahold of a psych appointment on a "good" day. Physical conditions are less subjective, so I wouldn't really worry much about those.... But, then again, we should just have universal health care and do away with the VAMC all together so more money can be devoted to compensation.

One of the problems with ALL of our law systems in this country (civil, legal, SS, VA, etc) is that there is always someone that has entirely too much power in the process. A jerk rating's officer can ruin someone's life for years.....A jerk SS judge can make your life a nightmare, just as a rater at SS can before him. The same goes for criminal law.....one Ahole judge having a bad day and your speeding ticket turns into 5 days in prison. Conversely, a good judge/rater can make life a wonderful thing...... But, I guess our systems have some checks and balances which is better than most other countries......

Agreed. I think it's actually a good test for a med doctor for folks with PTSD (if you have young kids). If you go into the psych for your kid and he wants to start giving out meds for something like ADHD, then say no thank you and move on to a new doctor. A "good" psychiatrist should be giving the absolute minimal therapeutic dose of medications, be it for an adult with PTSD or a kid that is hyper. Actually, I just recently took my son in because I'm afraid he is prone to anxiety issues like his mom. He has been having mild panic attacks in anxious situations (his heart rate went through the roof at a physical because he thought the doctor wouldn't clear him for football). So, I took him to my wife's psychiatrist and the psych basically said that it is probably due to hormonal changes (normal for an 11 year old) and he *could* outgrow it. He gave me a PRN script for ativan for the attacks, but said I really don't need to use it unless I think he's having a really severe attack and cannot calm down. He also said that most ADD cases are just kids being kids and that it is more likely a developmental part of one's autonomy and NOT a mental disorder....needless to say, this psych doesn't give out meds to kids very often and he specializes in child psychiatry. So, as I've said in other threads, if you don't like how your psychiatrist is prescribing meds, fire his/her butt and find someone that's willing to work with *YOU* (general you, not husker in particular:-)

I don't think meds are the problem; if anything, medications for psychological disorders is a step in the right direction because it denotes an underlying physiological problem. However, some people react differently to different meds, so they can be real hit or miss, but we KNOW that certain symptoms like depression, psychosis, anxiety, etc are partly due to chemical imbalances in the brain (dopamine, serotonin, etc) and drugs can improve on that imbalance. I know my wife would be dead right now if not for those anti-psychotics....she clearly has a dopamine reuptake issue and requires some form of anti-psychotic to control it.

The problem with most psychological "studies" are that they rely heavily on self-reporting statements, which I think is complete BS. Ironically, several studies have shown that 90%+ of the population lies several times a day and will lie even if there are no possible consequences for lying; yet those same psychologists rely solely on people telling the truth in those studies, lol:-) I recently read one study where very basic questions were asked of people like, "how often do you drink beer" and "how often do you eat fast food"...the study was completely anonymous, yet the researches found 100% of them lied. They basically went through the participant's trash to find that they were grossly underreporting their answers. Why do people do this? In my opinion, it's because people are lying to themselves......admitting they drink more has a negative connotation so, in their minds, they don't want to admit that they drink/eat fast food. The same can be said for studies on rape, aggression, anger, etc.....who wants to admit that they are aggressive and what defines aggressive? Who wants to admit they were raped or molested no matter how anonymous the study is? Let's face it, the field of psychological is merely educated guess work based on studies that are extremely limited and likely wrong. But, as you stated, therapy can help people help themselves by pointing out flaws in logic and giving better ideas on how to solve certain problems (and prevent them before they occur). In the end, however, therapy is only useful if people are capable, and willing, to help themselves and that means admitting to one's own faults, which brings me back to my first paragraph.....

Read the most recent notes from the senate hearing on PTSD in which the psychiatrist made it sound as if cognitive behavioral therapy could "cure" PTSD and that 100% PTSD vets should go to work to get better. Many, many psychs think "therapy" can cure mental disorders. If you don't buy into that, which you shouldn't, then you could make a good therapist:-)

A lot of fields have post-doctorate work that can be done, but there is no official degree beyond the initial doctorate (outside of getting more doctorates in other fields). Honestly though, I would tend to agree with your assessment....in the government's eyes, you should be capable of paying for your own grad work if you have a bach already. Pell grants, and most other government aid, is limited to one bach. In fact, WA just passed a new law that allows 100% vets, and their dependents, to go to school completely free for your first bach degree...anything beyond that is on the vet to pay (outside of the ch 35 ben).

I don't despise therapy at all, especially in that context. However, I do not like when therapists/psychologists try to act as if they can cure major psychological disorders with "therapy". There is zero evidence showing that stuff works at that level on a regular basis and I think it does a disservice to those with severe disabilities to suggest otherwise. At best, therapy can help severely disabled vets learn to live with their problems a bit better (like giving morphine to someone with a broken arm). Therapy for more minor/mainstream issues can be very helpful though; it can even be helpful for those who live with people with severe PTSD. Sometimes people need a third party that can help them sift through their daily problems.

There's a simple explanation for this and the VA could save $ if they would just use some common sense. There's a HUGE difference, for those with mental disorders, between working because you HAVE to and working because you WANT to. Money is the #1 stressor for all of us, regardless of our mental state, and most folks with anxiety issues (IE - PTSD) have BIG issues with authority and feeling "trapped", both of which are negated if you are only working because you "want" to work, because you always have the option of leaving. If the VA would just lock folks in (just like the 20 year thing), but after, say, 5 years (or when P&T is determined) then folks with PTSD should be able to work, but have their VA compensation reduced by the amount they are earning (net of course). This way, PTSD folks can attempt to work, but without the pressure of "needing" the job and/or money, which alleviates the majority of issues they have with working in the first place. But to do that the VA would have to accept that 100% disabled PTSD vets almost never get better (to a point of gainful employment at least), but I think they are still influenced by the idiots that think a good talking to can cure a 100% PTSD vet! A program of this sort would save the VA money and improve the quality of life for many PTSD veterans......

Post grad work in clinical psychology is a PsyD, not a PHD. Also, your issue sounds far less subjective then something like PTSD, depression, etc. Either way, I have not said that the VA would *not* accept a psychologist's opinion...they even accept opinions from NPs and PAs, but only because they are cheap and cannot afford to get *good*, educated opinions from qualified personnel. In terms of IMOs, though, one would be a fool to try to overturn a VA decision based on the word of a NP, PsyD or PA.....even an IMO from a pscyhiatrist can be shaky if it's a one time appointment and the psychiatrist doesn't specialize in PTSD (or whatever disorder you're going for). Try winning a SS case that is contested with only an opinion from a PsyD...... Again, a psycholigist and a psychiatrist are light years apart in terms of education and qualifications....if the VA doesn't see that, then they are dumber then even I thought:-) BTW, as per the norm, the VA will weight things against you more than those FOR you. The reason they tried to bust down my wife's A&A rating a couple of years ago was based on a letter from a NP that stated ONLY that she was able to handle her finances for fiduciary purposes....the letter made one mention of her PTSD and said, "her PTSD does not seem to affect her ability to understand her finances". They used this to reopen her P&T A&A claim and lower her all the way to 50% on that alone, yet when I had the same PA write a letter saying that he made no diagnosis of her PTSD and that upon evaluating it he found it to be completely disabling the RO said, "a PA is not qualified to make that decision".

This is just a misconception on how one should seek treatment in terms of mental disorders. One should only go to a psychiatrist for medicine....it is not their job to give you therapy or try to fix you through unproven psychology methods. A psychiatrist should only be assessing your problem and finding the right combination of medicines to alleviate your symptoms. However, some psychiatrists will offer therapy as well as meds, but NO insurance on earth is going to pay 10x more for therapy from a psychiatrist when they can pay 10x less for a therapist/psychologist. This is a fundamental flaw in our medical coverage in this country because insurance will typically not pay for someone to see a psychiatrist AND a psychologist at the same time. So, most folks are left paying out of pocket for one or the other. As for my wife, we try to see her psychiatrist only for meds and as infrequently as we can to save money (every other month mostly). Also, a psychiatrist works for YOU, not the other way around, so if you feel that one is over-medicating you and unresponsive to your complaints then fire him/her and find someone better. Every person reacts to meds differently and a good psychiatrist should be attempting to medicate you as little as possible while still having a therapeutic effect. As for giving a psychologist the same weight as a psychiatrist - I would want to see BVA/CAVC cases that actually give two diverging opinions exactly equal weight when one is an MD and one is not. It makes no sense that any evaluating body, be it government or otherwise, would apply equal weight to two opinions that have vastly different educational backgrounds. Comparing a psychologist to a psychiatrist is like comparing george bush to eintstein:-) Of course, that isn't to say that psychologists are idiots, but there's a reason why the average psychologist earns as much as a factory worker with a high school diploma while a psychiatrist earns 200K/year.

"The VA will allow a psychological diagnosis from A PHD in clinical psychology." Hoppy, I don't mean to be rude here, but I have a fair amount of education in this field and I think there are some misconceptions as to what a psychologist is and what education is required. A "PhD" is a doctorate in philosophy. If a psychologist has a PhD they can actually spend very little, to no, time in clinical psychology. A doctorate that emphasizes clinical psychology would be a PsyD, which many psychs have. For ratings purposes there is a HUGE difference between a psychiatrist and a psychologist because a psychiatrist is taught the physiological basis for mental disorders and how to treat said physiological problems with pharmaceuticals. A psychologist can only make an observation of symptomology and diagnosis accordingly. Let's put it this way - If I gave you several books on the theories of freud, erickson, piaget, etc and you spent 3 years studying them, would you really know any more about why and how something like PTSD works? Now what if I taught you how recent research in brain lateralization (how one side of the brain communicates with the other...IE - hemispheres) has shown that some forms of hallucinations and fears/anxiety could be due to one side of the brain perceiving the other as a foreign body? What if I taught you the physiological reasoning behind most disorders like elevated dopamine due to reuptake disorders between neural transmitters and how to prescribe medicine that alleviates that problem? In other words, psychology, in general, is nothing more than "theory" that is unproven and relies heavily on subjective observations; whereas, psychiatry follows the medical model and assumes that there is a physiological basis for "mental disorders". Psychiatry is far from always being correct either, but they have FAR more education about human anatomy and how the brain works than ANY psychologist....a psychologist is nothing more than a therapist/social worker who had the time/money to go to school for 1-2 more years.

This is incorrect. First, psychologists are not "doctors" in the traditional sense; they merely have an 8 year degree which does not qualify them to dispense medicine any more than someone with an 8 year degree in basket weaving. NPs do not have to fall under an MD to give therapy, nor do therapists or PAs, but they must be under an MD to dispense medicine. Actually, NP's and PAs and more qualified then psychologists because a psychologist cannot dispense medicine even under an MD. In fact, many psychologists have a PhD, which is a general 8 year degree with an emphasis on psychology. A PsyD is an 8 year degree that is only in the field of psychology and focuses on therapy. If anything a NP and a PA has far more education on human physiology and the biology of mental disorders. Also, many nurses have doctorates as do many PAs, but they do not have medical doctorates (MDs). P.S. - A therapist (6 year, master's degree) has the same "license" to provide therapy that a psycologist has and both of them could have quit going to school after their associates, because one learns next to nothing in the field of psychology beyond a few classes....most of their education consists of regurgitating past theories that are completely unfounded and unproven. In that sense, psychology is more faith than science. BTW, I am pursuing a masters in psychology right now and I stopped learning anything new in this field after my first general psychology course....therapy is a joke, period.

Josephine, Thanks for the kind words:-) Where do you live by the way? The best way to find a good psychiatrist is to use your yellow pages and start making some phone calls....be sure to say you are a cash customer and that you are shopping around for a med doctor and an eval. I know some areas have far more psychs than others (rural areas are extremely limited), so you may have to drive a bit to a major city to find a good one. Perhaps you should write something up (formally) and send it to the prospective psychiatrist so the psych knows what you're looking for, so you don't have to waste time/money on one who will not be favorable to your case. As far as getting them to review your records for a nexus: Time = money, so understand that every hour they spend on reviewing your records and writing an opinion = an hour's worth of billing you must pay them. Considering most psychiatrists charge upwards of $200/hr+, it will likely cost you somewhere in the neighborhood of $400 - $1000 or more. If they know you are willing to pay them for their time, they will pretty much review anything you want.....it's easier on them to review paperwork then to schedule appointments, because they can do the review on their spare time and still charge you the full rate. However, you need to keep things short and sweet or they can get lost in the paperwork and not be concise enough for the VA to sound educated on the matter. So, hammer home the nexus issue with documentation showing your anxiety while in service and leave out all of the VA mumbo-jumbo. On top of that, get a good eval that strongly discredits the personality disorder thing and that shows your disability in a manner that you feel is correct. You may even need to do this with more than one doctor to get a favorable decision, but I think the key is to establish an ongoing relationship with a civilian doctor in order to build a strong case down the road. If you just get some IMOs without any long term care the VA will likely discredit it as "buying an opinion".

Many psychologists/NPs/PAs work under the direct supervision of an MD (be it general practice MD or a psychiatrist). SS did accept my wife's NP's eval for SSD, but the NP had to have her residing psychiatrist sign off on the eval in order for SS to accept it. This was about 5 years ago and it was for her initial award (not a continuance), so maybe things have changed or you are refering to maintaining SS rather than being awarded SS. I know my wife's last eval for SSD consisted of a self-reporting statement saying she hasn't improved....nothing more.

That's the beauty of an IMO; you are in charge and you can fire them if they say something you disagree with:-) The wife has been seeing the same civilian psychiatrist for about 1.5 years now and we're about to fire him when we find someone better. During a recent episode of her's the psych completely missed that she was in a psychotic/dissassociative state and completely bought into her "coping mode" as if she had made some miraculous recovery. His utter failure at his own profession means he can find a new patient in my opinion! Again, psychiatry is voodoo medicine, so find someone you feel best fits your needs/wants....most of them are over-educated idiots anyway.

Mental issues are subjective in the eyes of most people in this country and the VA uses that subjective nature to put wholes in every mental disorder they see. This is why I always strongly suggest using civilian care when one has a psychiatric disorder and staying as far away from the VA as possible....mental disorders have highs and lows by nature and although the VA is "supposed" to rate someone based on the lows and how often those lows occur, they do not; rather, they will focus on any shred of evidence that can be used to deny/low-ball a veteran. So, if you want to fix your claim (and you can) you have to be vigilant and get some very hard evidence to win your case. This means spending some $ for *good* IMOs from highly qualified psychiatrists (IE - if you have PTSD see a psychiatrist that specializes in PTSD/anxiety disorders). The VA is like any civil law suite, you must prove your case by a preponderance of the evidence and shoot holes in their case against you wherever applicable. For you, this means getting more evidence stating that you do not have a personality disorder and having more evidence then they do showing that you have a well-founded nexus. It may take a year, or more, but you CAN win your case. Perhaps finding a *good* psychiatrist and sticking with him/her for several months+ would be the evidence you need....the VA would be hard pressed to ignore your treating psychiatrist's eval even if there are dissenting opinions because your IMO opinion would be over a lengthy period and the VA opinions would likely be very short interviews with little medical background on your disorder. It's sad that the VA uses these tactics, but you can beat them at their game if you go about it in the right way and take your time.

Be more up front with your psychiatrists. Tell them what you expect of them in their eval and how to format it. Don't make it sound as if you're paying for a favorable diagnosis either, because that's not what you're seeking; rather, you should tell him/her to be honest in their assessment, but to include items XYZ in their eval and use verbage like "more likely than not". It is best to write up a formal paper on what you're looking for and to include a sample eval that the VA would find acceptable, because you'll never get all your points across in a single eval, nor will the MD remember the finer points of the conversation (time = money). So, shop around for a good psychiatrist (one psych can vary greatly from another...this field is far from an exact science; in my opinion, it's closer to voodoo medicine) and be prepared with what you're looking for out of them. Also, pay in cash because psychs LOVE cash customers......use insurance and you'll find they're booked for 2 months; say you're paying in cash and you'll be seen this tuesday:-)

Vike is absolutely right here. In fact, SS won't even take the opinion of a psychologist unless a psychiatrist signs off on said opinion. The same goes for the military.....my wife had been seeing a AF psychologist (captain) for about a year before she initially broke down, but he was not allowed to do the eval for her medical boarding; instead, she had to be pawned off to an AF psychiatrist at a neighboring base that knew nothing of her case. In terms of education, psychologists and psychiatrists are light years apart even though both may hold doctorates. This is why the average psychologist earns around 50K in the US and the average psychiatrist earns about 175K+. A PsyD is nothing more than a LOT of schooling based on outdated psychological data from 40+ years ago and a ton of writing/clinical observation of behavior. A psychiatrist, on the other hand, has a MD and knows EVERYTHING a psychologist knows plus has far more knowledge of the physiological effects of various psychological "issues" on the brain. As far as most government agencies are concerned, a psychologist cannot even diagnose you, let alone write a formal eval...they simply are not qualified to do so. A psychologist is for therapy, not diagnosis. The only reason the VA gives them any weight is because they cannot afford to send every vet to a psychiatrist for a C&P (would cost 5x more), so they have cheated and used people unqualified to do C&Ps and, therefore, are forced to accept IMO from those under-qualified individuals. A psychologist/NP/PA should be used only in conjunction with a qualified medical professional (IE - an MD).

Tss, I'm sorry I haven't written sooner, but the wife decided to stop taking her meds and subsequently had an episode that landed *ME* in jail on July 4th (not one of my better holiday memories)....long story..... Anyway, the VA tends to use your GAF against you and not for you. In other words, if your GAF is low, they will ignore it; if it is high they will use it to low-ball you. It's standard stuff for PTSD. I just got back home today and I really don't have time to read all of the posts since the 4th, but, with what I have read, I would say that you should get a copy of the VA criteria for mental disorders and use it in conjunction with some good IMOs to get a better, and more fair, rating. In each of my wife's decisions they cited that criteria word for word in their decision, so you need to provide that to your IMO (or IMOs) in order to word your appeal appropriately. As for the daily function stuff - that seems more like an aid and attendance issue then PTSD. Although the 100% level does mention an inability to care for oneself in terms of basic daily functions, I don't think it's a point of emphasis for the VA raters. In fact, I don't think I've ever heard of the VA awarding A&A based on that criteria.....my wife's A&A was due to the threat she posed to herself and others and made no mention of her inability to bath, feed and take her own meds. It's probably not impossible, but I doubt the VA would give much weight to someone who, in essence, "chooses" not to groom themselves (though I strongly disagree with that statement; it is how most people feel in this country). Anywho, I'll check back in as I can, but I'm trying to keep the wife out of the mental hospital ATM and dealing with a with a legal system that is completely ignorant about severe mental disorders. BTW, if anyone lives in the state of WA never, EVER call 911 for anything...you're better off letting someone kill you before calling those bastards!

Well, the difference is that PTSD develops due to a severe stressor, so it's unlikely that someone would develop PTSD while in the military, yet have it non-military related. It's certainly not impossible, but highly improbable:-) I wonder how they would handle PTSd with delayed onset if the stressor was preexisting, yet it did not "mainfest" itself until one entered the service? That would be tricky, in my opinion, because it would depend on whether or not the person technically had preexisting PTSD or not?...when does PTSD technically start in that case? As you can see, it's not so blac and white with PTSd (or doesn't seem to be to me).

That's a VERY shady area though, especially in terms of PTSD. Also, isn't there a difference between a condition "manifesting" itself while in service and one that existed prior to service that gets worse for no apparent reason (IE - not the military's fault)? I'm not 100% sure, but I think there's a difference between getting cancer while in the military and having cancer once you get in that is discovered after the fact. I'm not entirely sure though...seems like a grey area.....

If you were healthy enough to pass basic plus the rigors of war, than one should assume that your preexisting PTSD was not at a level that was terribly disabling. If, after the fact (due to the war), your PTSD symptoms now rise to the level of being disabling then the military did indeed aggravate your preexisting condition. So, you should certainly file a claim, but PTSD is a hard fight these days and I'm sure the RO will use your prior issues to deny your claim. But, in the long run, it sounds like you have a solid claim provided you have a verifiable stressor and you can prove that said stressor led to a worsening of your condition. If I were you, I would downplay the early PTSD as mild depression (which you admitted to) and/or anxiety, which had a minimal impact on your life. The less you talk about the past, the better in my opinion.